Dr. Kate

Over 30 years ago, I had a BA in biology, was in a MA program in History of Religion and needed a salable skill. A nursing program took a chance on me. And, I found that nursing suits me. Is nursing my passion? No, but I am passionate about nursing. The notion that one must be passionate about one's job is a bit misguided. Better you should think about what suits you as a person, what suits your personality, your needs, your plans for the future. If you are thinking that you will work days, Monday through Friday, with every holiday at home with your loved ones, go find something other than nursing. There are already plenty of nurses who have that as their goal. But, if you find that working with all kinds of people, people who behave in ways you can't even imagine, people who most of the time you will see at their worst, and many of whom will not thank you for what you have done for them--come on down, it's not a bad place to build a life.

So you know, within the state of California the public junior colleges are mandated by law to use some form of lottery system. It sounds unfair now but was a response to the perceived unfairness of individual programs setting their own standards. The pre-reqs are pretty much the same, so doing well on those will make the nursing program more understandable if not easier. I usually suggest that students apply to 3 to 5 programs. Be aware that you will be going to clinicals which are usually in the general area of the college you attend. General area is a nebulous thing, I've had students who drove over 30 mile to get to clinical. Not so bad at 0530 but a bear in the afternoon. The distance you have to drive to school and clinical can negatively impact your experience and time management plans. Selecting a school is more than just finding the one you can get into easiest or quickest. Be sure to investigate NCLEX pass rates, ask questions about the program itself, ask about how many students from the last year have gotten jobs, and where did they get those jobs. Good luck!

I really wanted Kathy, but that was taken. The only other screen name I use is what I used to call my dog and I didn't want that for a nursing board. I lack creativity. Some of my relatives call me Kate. When I got my PhD a friend playing off Dr. Quinn Medicine Woman addressed the card Dr. Kate Library Woman. That was more creative than I am so I went with it. This is the only place I use the Dr. and really should change it as I find it a bit pretentious. But procrastination is my best thing . . .

It strikes me that perhaps you could do with some time taking care of people in a setting where you have a bit longer contact with them than you do in the ER. I become concerned when I hear relatively new nurses sound like old veterans. Truth is you haven't seen enough on your own to be that jaded. More likely you have picked up on the reactions of your more experienced coworkers. Reconsider another area, some aspect of critical care can give you the excitement you enjoy and the contact with patients you need to be the nurse you want to be. Just a thought.

You might want to check your state's nurse practice act for the details of what constitutes RN practice. There should also be a board for the LVN/LPN group. There's a lot of hearsay that goes on among nurses regarding what they are and are not responsible for, your nurse practice act will clarify that for you.

Heavenly blue, if perfect eyesight was required we'd never get any new nurses. As long as you can see well enough, somehow, to be safe and are careful, come on down. And welcome aborad, it's a great ride.

Hard to tell. Within both corporations I work for the individual hospitals specify the length of new grad orientation. One has a standardized framework for the didactic, but total length is up to the facility and always negotiable depending on the individual new grad.

Sometime in the late 80s thought was that if we taught patients to give themselves their own insulin and not double check that there was no reason for nurses to double check. Well, times change, things happen (sentinel incidents) and what looked like "old school" practice becomes standard practice again. I have worked places where insulin, heparin, dig, and a few other things were double checked and documented. Here and now, the double check is done but there is no documentation. In Peds, Nsy, NICU they double check all drug calculations. It does make sense. With medication errors being a national patient safety issue, better safe than sorry.

While there is little that you can do to stop physician denying having given a particular order, reading back orders and documenting that you did it is little enough to do to make sure you as the nurse have done all you can to verify the order you took was the one given. I was taught to always read back the orders I took over the phone. I've done it when the doc didn't want to hear the orders again, when I was "too" busy to waste the time reading the orders back, and on rare occasion had a doctor change an order on read back. It's an unfortunate commentary that in my facility we have had errors because a nurse was obviously unclear on what was being said or heard and didn't ask for clarification or spelling. Does it irritate a doc to have to spell something, usually. Does it protect the patient and the nurse, yes. Also, despite evidence to the contrary, docs are made aware of these sorts of rule changes. And, in well run hospitals, they are held to following the JCAHO rules that have made their way into the medical staff bylaws. As much as a lot of what JCAHO requires seems silly or irrelevant, most of the requirements are ther result of a number of adverse events that have in some way put patients at jeopardy.

I truly hate it when nurses treat agency nurses like dirt then have the gall to make them DNS because they didn't do everything dumped on them. I also hate familities that let nurses get away with making an agency nurse a DNS because they don't like them (the nurse stood up for him/herself), he or she has green eyes (they don't say that but it's the only thing you can think of might be the problem), the phase of the moon is such that all agency nurses nust be made DNS. Having said that, you don't want to work at a place where you are treated so shabbily. You don't want to work at a place where the charge nurse does not respect your level of competence and your unwillingness to act outside your level of competence. Be glad you're free of them before they really put you into a situation where something bad could happen.

Go to the library. Ask the friendly librarian for help. To get this information you're going to need to get into some older material, 60s and 70s stuff, maybe older than that. See if you can get a hold of a copy of Thora Kron's The Management of Patient Care, from the 1970s. She does a nice job of describing the various systems of patient care delivery. And not to be too contradictory. While your instructor is right that these are antiquated systems of care delivery, they are very, very efficient means of delivering care when there is shortage of RNs. No one should be too surprised if we start to see these older systems of care delivery "reinvented" and/or reintroduced as the shortage of RNs becomes more acute. Oh, functional nursing involves having a specific nurse who does medications, one for treatments, one for orders/unit management, and some for direct physical care. IMHO, the greatest benefit of team nursing, and probably functional, is that they provide a way for nurses to leanr the skills of supervision while dealing with patient care. I am convinced that the wealth of bad managers we are seeing today are a direct result of no one having leaned supervisory skills at the patient care level. (No one has learned team nursing since somewhere around 1980.) I really think that to manage people you haev to learn the skills, and functional and team nursing helped nurses learn them. But that's just my opinion.

Back in the days when I was wearing a cap, my hair was always short. We had no option about wearing our cap and it had to stay on. The first thing I did was to tell my hairdresser I was going to need to keep a cap on my head. Richard was a genius with short hair and did something--left the top a bit longer I believe. Anyway, I always managed with two bobbie pins--one on either side of the back. I never had the right hair to make a comb work right--on me it slid right through my hair and the cap sailed away. When I started working in critical care, and ended up tangling myself by the cap in our ceiling mounted IV poles, my cap stayed on and I'd be caught by the thing still stuck to my head. I learn quickly, got rid of the cap.

It's been years ago and thigns were sometimes a bit lax in the safety area. In ICU we had fewer TVs than rooms. The TVs were on high stands and went from room to room. The cords were of varying lengths and depending on the room and the patient's visualy acutiy sometimes were stretched a distance and 12-18 inches off the floor. The plastic surgeon was at the head of the bed suturing the patient's face, the TV at the foot of the bed (door end of the room), cord 15 inches off the floor. I scurried in with something, tripped gracefully over the cord, slammed onto the floor elbow first, didn't knock the TV over, and had both the surgeon and the patient asking how I was as I delivered whatever I was bringing into the room and slunk out, pretending I was fine. Mostly embarrassing and beat when I slipped on water and fell on my orifice.

I also work in both a Catholic hospital and a for profit non-religious one. I concur with everything said above. The Catholic hospital where I work was bought 6 years ago by another Catholic system. The difference is the way those two organizations runs things is like night and day. That's a corporate culture thing. The biggest differences I see between the Catholic and the not is in the use of the Chaplain. Chaplains come in for those life altering things that happen in a gentler, less obtrusive, more humane way than do the social workers who do similar things and they tend to be less harried and rushed. The involvement of the ethics committee in care issues is greater in the Catholic hospital. It seems to help to have a defined tradition backing up the ethical decision making. I prefer working at the non-religious hospital because as I have grown older I have become less and less tolerate of hypocrisy. I find I hold the Catholic hospital to a higher standard--I expect them to really do those things they post on the walls about the mission and values of the organization to their employees as well as their patients. (Again a corporate culture thing.)

I agree that referesher courses tend to be focused on adults and that is not what you want to do. However, you have no acute care experience except for school, 10 years ago. It will be a challenge to find someone to hire you into NICU. I go back to the rest of what I said, get out there and talk to recruiters, NICU managers, and the folks in education--they're the ones who do and recommend the hiring. I can only speak for my hospital and neither the recruiter nor the dir. of ed. would pass you on without a more substantive commitment than I read the book and worked on calculations. The dept. manager might be more accommodating. It isn't that I don't think it can be done, it's that it isn't going to be easy. llg is right about the emotional aspects both of NICU itself and being a novice again. I had "romantic" ideas about NICU and went so far as to start an NICU didactic course. I knew I was in the wrong place when the instructor started talking about finding a baby in a puddle of blood equivalent to most of the baby's blood. Far too scary for this adult ICU nurse. I also know about being a novice after being an expert--that can be very, very hard on the self concept. What helps is knowing that you are able to become an expert because you have been one before. One last thing, if working with the sickest of the neonates is your heart's desire get out there and find a way to do it. Life is too short for regrets and wondering about what might have been. Good Luck

While I think you're nuts, I think I understand the motivation. Since you do not have any recent clinical experience you will need to take a general refresher course. I recommend you do this before approaching a hospital. It will be to your advantage and the hospital's if you have already done the refresher. There may be some hospitals that will put you through the class, or even give one themselves. Then you need to find a hospital that will train you to NICU. Ideally, you want to find yourself in a new grad type program with lengthy orientation period in NICU that includes specialty educational programs paid for by the facility. I think it is possible for you to do this and all the pieces come together, But you will have to do some exploratory work. Talk to nurse recruiters, directors of education, NICU managers and find out what they are looking for, what the job and work requires, and what suggestions they may have for getting you where you want to be. (My friend the career counselor calls these information interviews. You are not looking for a job from any one of these people but information. If you write thank you notes as f/u to the discussions, when you are looking for a job, you will be remembered favorably.) Since this could be a major decision, I strongly suggest that you consult a career counselor before going too much further. They have a lot of tools and skills to help in even very subtle career decisions. Good Luck

Got my AA and BSN from different campuses of the same school. For both pinning was separate from graduation. When I got my AA the dean of the program pinned each one of us and gave us a rose. In the BSN ceremony, each graduate had someone special pin them. My Mom (an RN) pinned me, and even now I get weepy over that one (which really was superfluous in my case, though the pins were different.) I don't see too many people wear their pins these days. I did for years but stopped because the clasp was loose and my original pin was only used for 3 years and I will not lose it. It seems to me, it wouldn't be all that hard to have your own ceremony. There really is something special about that acknowledgment that you made it.

Mario made a comment that he wouldn't know what to do if he saw someone actually using drugs. I would hope that he, and anyone else who witnessed such a thing, would have the courage to let the unit manager or supervisor know immediately. People who are diverting drugs tend to be very careful. It seems that when they get caught it is often because they "want" to get caught, and get some help they don't have the courage to ask for directly. It isn't always easy to say something when it will impact a peer negatively. We have a duty to each other as well as to our patients. Great thread on a difficult and sometimes touchy subject.

Great thread, and it has taken an interesting turn. I concur this discussion is needed. I work full time in Education, and per diem as a house supervisor in another faciltiy. I have never been a manager. The highest I ever got, and the highest I ever wanted to go, was charge nurse. Being a house supervisor is a distinctly different activity, and requires a distinctly different perspective and skill set than being a manager. Some people can do both well, but in my experience those people are very few and far between. The salary issues are difficult. Where I work FT is union. I am the only person working in education, other than the director, who is not part of the bargaining unit. Many of our nurse managers were unhappy when their latest increases were not the same as those negotiated by the union for the staff. For two of them, it was the straw that broke the camel's back, and they left the manager position. My boss made the comment that all of her staff got better raises than she did. On the whole I would say that salaries for nursing managers are running a bit better than those for staff nurses. Are they sufficient compensation for the work and responsibility, probably not. But, as in all of nursing, there is more to a job than the salary. Unfortunately salary issues can make it hard to get promising staff nuses with managerial talent to make the switch to management. Someone asked about education. The most valuable classes I ever took were three supervision classes at the community college level. I learned about various types of organizational structure, how organizations work, how people function in groups and organizations, and some of the fine points of dealing with people at work. I still remember the instructor telling us that even if we weren't supervisors it was important to take supervision so we would know what was going on in our organization. He was so very right. One thing that has and continues to distress me is the seeming reluctance to go out and get the education needed to do the job. I watch new managers, with no experience, wait for the institution to put them into classes, or teach them the things they need to know. And, I listen to them wail and gnash their teeth because they don't understand what is happening around them.

The oldest was the 61 year old who lied about her age at the fertility clinic. That dad, I think he was 65, was so happy he just floated dwon the halls. A few months ago there was a follow up in the paper, the little girl is 4 or 5 now, doing well. I wouldn't even think about it but that family was so very, very happy. My Mom was 37 when I was born. That was in the 40s when 37 wasn't just old, it was ancient. My Dad was 48. As far as not being there long enough. My Mom's mother died when she was 8. You have your parents as long as you have them. The time is a gift.

As someone who taught briefly in a private high school the year before I went to nursing school, back in the days when kids were a bit better behaved than they are now, nursing was a whole lot easier. At least most sick people want what you have to offer. Most high school students don't want anything you have to offer and you have to make it appealing to them. Sorry to be negative on the subject. I really like teaching. However, I am a rotten policeperson. I was very young then and saw myself as ridiculous in the position, that had a lot to do with the difficulty I had as a teacher. I do agree if you want to teach go through certification classes. I know that would have helped me immeasurably. Good Luck.

Going back to the original poll: maybe the benefit that is really needed in nursing, more than better pay, ratios and the aassorted other things we all would like, is real sabbatical time, just like in academia. Think about it. Three, six, twleve months paid time off with insurance paid, every seven years. Time to rest and refresh one's outlook, psyche, and body. Time to go to school, to take classes for enrichment of one's personal and professional lives. When nurses are recognized as needing and deserving time to renew all their resources, and supported by the organizations that employ them in this, then nursing will truly be a profession. Now, as for work life. I occ. work as a house supervisor. I have been told by other house sups that I am "too good at saying no." As nurses we must learn, or get the therapy needed to learn, to say "no' to those things which are detrimental to us as human beings. We need to know the difference between doing a favor and being taken advantage of because we want to help or just can't say no.

Technically the instructor is the person responsible for the student. You are responsible for the patients assigned to you. What I have a real problem with, and this is nothing against you, is letting a student be with a new grad. You're too new yourself to be any kind of a resource to a student. Students and their instructors have a tendency to talk about the student "doing everything" for the patient. My experience has been they mean they'll do physical care, meds, and charting. They may do routine treatments, occ can manage an unexpected procedure, rarely can handle interacting with and calling physicians, and never can deal with emergencies. Everything is quite a matter of personal definition. I do think your NM and the instructor need to set some parameters so the students get an optimal experience, and so that a new nurse isn't burned before she has a chance to become seasoned.

They're probably lying, or not telling the whole truth--like how much OT it took to get that average. There's a lot of work to be had in my area. You want the life style, you work--a lot. It's a rare nurse that doesn't work two jobs, one FT, one per diem. Some work two FT jobs. And Kaelie, don't be so hard on someone like me who went into nursing because I needed a salable skill. I stayed because it suited me. The ones who need to leave are those for whom nursing is a bad fit, no matter how much heart they may have.

When I first started as a house mouse, my preceptor had me use a small notebook with useful information. I never could find what I wanted in it. The next place had a pocket sized telephone directory and I made notes in that. Now I don't. I have never had the luxury of only having one book with all the info I needed in it. We always have had far too many books. And it just isn't practical to carry it all. I hate carrying anything I can't put in my pocket. Anything not in my pocket gets left somewhere. After too many years doing this I carry a copy of the census, my beeper, the keys, a pen, a highlighter, and some change. I write notes on the back of the census. Extensions I keep in my head or ask someone. Door codes--most of them I have memorized and miraculously remember. Thye're calling a trauma, gotta go.